Is the Internet making you ill?

Its a valid concern in the attention economy we live inmdashWho is drawing this attention What emotions are they evoking What product are we being warmed up to buy Essentially who is capitalsing our attentionConsider the frequency with which mental illness terms are hurled at us as we scroll Instagram or the social media platform of the minute Most of us are likely to identify with at least three out of the five symptoms listed We are constantly vigilant for ldquotriggersrdquo and have decided we are lsquoADHDrsquo on Thursday and lsquoBorderlinersquo by Sunday Mondays are for anxiety attacksThe concern is exacerbated by the fact that towards the end of his days Dr Keith Conners expressed misgivings about how loosely the label lsquoADHDrsquo Attention Deficit Hyperactivity Disorder was being applied to children in the United States leading to liberal medication for it Conners devised the 39item questionnairemdashcalled the Conners Rating Scalemdashfor diagnosing and treating ADHD It has become the worldwide standard for assessing the severity of the disorder thatrsquos characterised by trouble paying attention and controlling impulsive behavioursAs the popularity of the scale grew in the late 1980s psychiatric drugs such as Adderall and Concerta were widely prescribed to the point of an epidemic of overmedication They became study aids for any striving student diagnosis or notDr Zirak MarkerThe Indian psychiatric drug market though small will be the second fastest growing market up to 2023 expanding at an annual rate of 134 per cent In 2019 the market was valued at around 16 million by 2023 it is estimated to be worth 25 billion as per The Business Research CompanyAre we headed to an epidemic of overmedication too Not yet say mental health professionals ldquoItrsquos not just the mental health industryrdquo says psychologist Salma Prabhu ldquoThe pharmaceutical lobby jumps into benefit from any and all perceived illnesses However luckily in India when I see articles or advertisements by them on the Internet they link the browser to a mental health professional they can connect to That is a better optionrdquoDr Neeraj Ravani a neuropsychiatrist points out a crucial detail Pharma companies canrsquot sell psychiatric drugs directly to patients they have to be prescribed by a qualified doctor ldquoIf a patient comes to me and says lsquoDoctor I took a test on the Internet and I have ADHD please give me medicationrsquo I would use my clinical judgment run some tests and get details from parents if possible about the patientrsquos childhoodrdquo he says ldquoShe may have anxiety and I write a prescription accordingly Just anxiety could also shorten attention span and cause memory difficultiesrdquoThe first step of psychological diagnosis is rating the severity of the disorder on the DSM5 scale The Diagnostic and Statistical Manual of Mental Disorders is a tool and reference guide to diagnose classify and identify mental health conditions ldquoThe measures are MildModerateSevererdquo says Prabhu ldquoOnly a qualified doctor can prescribe appropriate medication much can be managed by a change in lifestyle and dietary changes as well REBT Rational Emotive Behaviour Therapy I donrsquot even accept learning difficultiesmdashmost children can be integrated into mainstream education using play therapy or changing their diet if caught earlyrdquoSalma PrabhuPrabhu resists ldquolabellingrdquo any mental discomfort promptly ldquoWe assess the patientrsquos reliance on escape mechanisms such as impulsive shopping or eating and daily functioning abilitiesrdquo she saysBut wersquore not in the clear yet Perceived symptoms of mental illnesses do drive us towards impulsive consumption ldquoWhen you are playing Candy Crush and winningrdquo says Prabhu ldquoyou experience the rush of dopamine releaserdquo The neurotransmitter cultivates an intense feeling of reward itrsquos in our nature to prolong this rush which shopping eating or just smelling freshlybaked bread can do Our RAS Reticular Activating System also comes into play here You know why you feel a surge of relaxation when someone kneads the base of your neckrdquo asks Prabhu ldquoThatrsquos where the RAS is It filters incoming stimuli and keeps you motivated to behave in a certain wayrdquoBack to your last life on Candy Crush ldquoThen pops a message saying you can get six more lives just by watching an advertisement Most likely the ad will be about something you have recently been browsing and of course you will buy itrdquoNot just dopamine architects of consumerism also efficiently utilise negative emotions You see posts validating your stress or ldquohard dayrdquo it could have a list of symptoms that you identify with not because you have the disorder but because they are normal life challenges Then come posts promoting selfcare through a beauty regimen or a cupcake ldquoYou tell yourself lsquoI deserve at least this muchrsquordquo Prabhu says ldquoFood especially gives instant gratification Even more so after the pandemic because there are so many new colour kitchens and home chefs and delivery services You tell yourself you deserve lsquoat least this muchrsquo because you work so hard but donrsquot question why you work so muchrdquoAccording to her a real selfcare process is acknowledging the problem identifying and reducing exposure to triggers and making a plan that includes rest a therapeutic activity such as painting or dancing and stressreduction techniques such as breathing exercisesOn the whole mental health professionals are glad for conversation about mental health and the reduction of associated stigma in society ldquoWhen I started my practice 22 years agordquo says Ravani ldquoA patient would turn back from the waiting room if she saw someone she knew Now patients are told by family partners colleagues and friends to seek help and given referencesrdquoEventually the proof of the pill is in the relief ldquoSo many molecules medicines do well in research but die out in the marketrdquo says Ravani ldquobecause they donrsquot work in reallife scenarios If my patient does not feel better week on week I have to change the prescription Eventually the molecule will die outrdquoAnother reason we are not at peril of being over medicated yet like in the West is the difference in how pharma companies woo doctors in the USA and here Dr Zirak Marker who works with children and adolescents trained for two years in New York City before building a 20year practice in Mumbai ldquoThey really court you aggressively there They wine and dine you fly you to free seminars and workshops In India they sit in the waiting room until you give them five minutes They have just enough time to give you relevant information Tell you about the new molecule what clinical trials have proven whether it is FDAapproved and what it can be used for We take the literature and go do our own researchrdquo Marker says about pharma sales representativesWe donrsquot have the fulcrum of health insurance policies that the US has to tilt the scales in favour of pharmas A New York Times article dated July 13 2017 lays out how the reckless prescription of stimulant drugs made ADHD look like an epidemic much to Dr Connerrsquos regret ldquoIn 1991 the United States Education Department made students with ADHD officially eligible for special education which accelerated rates of diagnosis and drugmakers have aggressively marketed their products to parents doctors and adults who think they have attention deficitsBut in a 2013 interview with The New York Times Dr Connershellip expressed dismay that some 15 per cent of high schoolers reported having been given an ADHD diagnosishellip This is a concoction to justify the giving out of the medication at unprecedented and unjustified levelsrdquoIndia fortunately is not aping the West in this case yet ldquoMost of us old doctorsrdquo says Dr Marker ldquoare conservative about prescribing medication I canrsquot meet a patient for five minutes diagnose label and prescribe medication I need at least 45 minutes and most of us have a holistic approach If medication is needed we list out the pros and cons and address fears of dependency sideeffects such as weight gain and addiction Depression needs at least six to nine months of medication I explain that itrsquos just like taking tablets for Vitamin D3 deficiency it works on the symptoms but does not take the underlying disorder away That needs therapy and lifestyle changes and managementrdquoSelfdiagnosis is quite common he admits especially among the youth ldquoThey ask their parents to take them to a psychiatrist after filling out a multiple choice quiz onlinerdquo he says adding this is why he is grateful for our habit of a second or third opinion He cites the example of a 17yearold patient who had been prescribed medication for bipolar disorder after a 15minute consultation with another psychiatrist We decided not to put her on medication and relied only on psychotherapy and is on the mend After all one canrsquot change onersquos reality But a holistic approach to mental health equips us with the tools to control our reaction to it134Annual rate at which the Indian psychiatric drug market is expanding according to The Business Research Company